Quality of life and productivity loss in patients with ankylosing spondylitis using tumor necrosis factor inhibitors
Journal
International journal of rheumatic diseases
Date Issued
2023-03-20
Author(s)
Abstract
Dear Editor, We have read with great interest the article by Lee et al1 reporting a comprehensive understanding of the real-world treatment patterns of tumor necrosis factor inhibitor (TNFi) in patients with ankylosing spondylitis (AS) and productivity loss, treatment satisfaction, and associated factors. There are 4 TNFi considered in this study, including infliximab, adalimumab, etanercept, and golimumab. The advantage of this study was that the data collected is extremely detailed and novel, including annual household income, education, and body mass index, which helps us know more about this issue from a different perspective and may arouse much attention to the issue that has usually been neglected previously. However, we found some concerns that we hope to be answered. First, the authors used the Treatment Satisfaction Questionnaire for Medication (TSQM) to determine treatment satisfaction which can help us know more about patient preferences when selecting treatment. However, the TSQM in Table 1 only measured the treatment satisfaction once. Due to lack of comparison, we cannot confirm that different treatment patterns and injection types cause a change in treatment satisfaction. Furthermore, this study is a cross-sectional study that did not have a pre-measurement as a baseline to compare, so we can only know whether these factors correlate positively or negatively with treatment satisfaction in Table 3. Whether those factors will influence treatment satisfaction cannot be determined. It requires more information on the cause-and-effect relationship between those factors and treatment satisfaction to allow for the inference of risk factors in Table 3 which might overinterpret the result. For the same reason, we can only know the correlation between those factors and the annual cost of lost productivity time (LPT) in Table 5. It may also require more information on the cause-and-effect relationship between these factors and LPT to allow for the inference of risk factors in Table 5. Second, we noticed that patients with comorbidities were mentioned in Table 1, which is good for us readers to know the potential risks; however, there was no discussion of patients with or without comorbidities in the treatment satisfaction based on the TSQM. Some comorbidities such as heart disease, stroke, diabetes, hepatitis C, etc, might affect health-related quality of life (HRQoL) and lower HRQoL.2 It would be a confounder. Additionally, TNFi were often not used as first-line drugs. As a result, other drugs like non-steroidal anti-inflammatory drugs, analgesics such as acetaminophen, and opioid-(like) agents, glucocorticoids, and disease-modifying antirheumatic drugs3 could be considered, and the effect of concomitant use of other drugs on QoL/satisfaction could be discussed. In conclusion, the research is dedicated to AS patients and the use of TNFi. Further discussion can be made on TSMQ measurement and some potential confounders, which will contribute to AS patients' treatment satisfaction, and productivity loss. All authors (KSM, PK, KC, and CL) provided their ideas and critical contribution. KSM, PEK, KHC, and CHL contributed to the editing of the manuscript. KSM and PK contributed equally as first authors. KSM, KC, and CL contributed equally as corresponding authors. None declared. The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for profit sectors. The authors declare no conflict of interest. Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Not commissioned; internally peer reviewed.
Publisher
WILEY
Type
journal article